By 2030, one-third of the US prison population will be over age 50. Meanwhile, the HIV prevalence rate in corrections is four times higher than in the general population and older adults are an increasing proportion of these higher rates. Nonetheless, little is known about the barriers and facilitators to successful HIV treatment adherence that older inmates confront after being released from correctional settings where HIV treatment may be readily available and more easily maintained. The proposed study is designed to examine how older adulthood, having been incarcerated, and the correlates of HIV affect adherence to HIV medication and the psychosocial well-being of people living with HIV who are over age 50 and have been released from prison or jail in the last five years. AIM 1 of the study is to identify barriers and facilitators to adherence to ARV specific to older adults with HIV infection who have a history of incarceration through in-depth interviews with 30 HIV-positive former inmates (over age 50) who have a history of incarcerations in the last 5 years.
This aim will include exploring differences in three groups, stratified by length of time since their release from the last incarceration. AIM 2 is to characterize the post-release experiences and the social support networks (types, size, and their social roles) of these older former inmates and the influence of these psychosocial and economic experiences and social network characteristics on meeting the challenges and/or exacerbating the barriers to adherence to treatment and psychosocial well-being. Using findings from Aims 1 &2, Aim 3 is to develop and evaluate through focus groups a community- based, group intervention to support and increase adherence to treatment among older adults with HIV with a history of incarceration. The impact of this study lies in its promise of providing critical information on post- release experiences which could be barriers and facilitators to successful HIV treatment adherence among a rapidly growing but largely forgotten subpopulation of older adults living with HIV with a history of incarceration.

Public Health Relevance

This study will provide critical information on barriers and facilitators to successful HIV treatment adherence among a rapidly growing but less studied subpopulation of older adults with HIV with a history of incarceration. The findings are relevant in designing HIV interventions and policy for an aging population that is affected by the three combined stigmatizing factors of aging, HIV infection, and incarceration.